I like ice and I mean the type of
ice that you get from the refrigerator and not the type that you
smoke. I am one of those people who likes to fill their cup to the brim
with chopped ice and who then proceeds to chew on it after the liquid is
gone. I like to look at ice when it hangs on the trees making them
sparkle like diamonds. However, I do NOT
like ice when it touches my skin.
When ice touches my skin it
feels as if a burning hot poker has touched me; not a pleasant feeling I assure
you. People with CRPS should never have ice applied to their
affected body for several reasons. First, ice will only cause the blood
vessels to constrict more, reducing the blood flow to the extremities.
Secondly, ice will increase and enhance the pain. Third, it can damage
the nerve's myelin sheath (basically, the protective cover for the nerve) and
finally, it can accelerate the disease and cause a spread to other body parts.
I know, it feels good at the time
you put it on. I know it makes sense on some level; burning pain, apply cold.
But in the end what you are doing is constricting the blood vessels, reducing
the blood flow, and then when the ice is removed the vessels do not rebound
because the protective sheath around the nerve has been damaged. Each
application can cause the nerve to deteriorate causing more damage which is
what we are trying to avoid in the first place.
The following was provided by Dr. H. Hooshmand, M. D., P.A. of Neurological Associates:
The following was provided by Dr. H. Hooshmand, M. D., P.A. of Neurological Associates:
Ice Versus Heat
"In our study of ice versus heat tolerance, 87% of the patients could not tolerate cold and 13% could not tolerate heat. The infrared thermal imaging showed that the ones who could not tolerate heat (13 %) had advanced stages of sympathetic nerve paralysis rather than nerve irritation (death of the sympathetic nerve fibers rather than hyperactive nerve fibers). The area of permanent sympathetic nerve damage in late stage acted like a leaky radiator, causing leakage of heat through the skin which resulted in warm extremity and secondary intolerance to external heat. Meaning that due to permanent damage to the sympathetic nerve fibers ( after repeated ganglion nerve blocks or sympathectomy) the sympathetic nerves could not contain and preserve the heat originating from the deep structures of muscle, bone, etc. This minority of 13% of the patients did not have the hyperactive cold vasoconstriction of the skin seen in earlier stages of RSD. These heat intolerant patients would be classified as erythromelalgia, rather than the 87% RSD patients who have hyperactive sympathetic function with cold extremity and intolerance of cold exposure."
"In our study of ice versus heat tolerance, 87% of the patients could not tolerate cold and 13% could not tolerate heat. The infrared thermal imaging showed that the ones who could not tolerate heat (13 %) had advanced stages of sympathetic nerve paralysis rather than nerve irritation (death of the sympathetic nerve fibers rather than hyperactive nerve fibers). The area of permanent sympathetic nerve damage in late stage acted like a leaky radiator, causing leakage of heat through the skin which resulted in warm extremity and secondary intolerance to external heat. Meaning that due to permanent damage to the sympathetic nerve fibers ( after repeated ganglion nerve blocks or sympathectomy) the sympathetic nerves could not contain and preserve the heat originating from the deep structures of muscle, bone, etc. This minority of 13% of the patients did not have the hyperactive cold vasoconstriction of the skin seen in earlier stages of RSD. These heat intolerant patients would be classified as erythromelalgia, rather than the 87% RSD patients who have hyperactive sympathetic function with cold extremity and intolerance of cold exposure."
"On the other hand repetitive
application of ice freezes and coagulates the myelin (fatty tissue insulating
large nerve fibers) exactly like ice freezes and solidifies melted butter. As
the ice freezes the large nerve fibers, causing freeze damage to the myelinated
nerves, the patient develops sensory loss and pain due to permanent damage to
the large sensory nerve fibers. This aggravates the RSD by adding sensory nerve
pain of non-sympathetic origin to the initial thermal sensory pain of
sympathetic origin. As a result, Ice provides total anesthesia and relief
of pain for several minute the same way as the hand becomes numb being exposed
to snowballs in the winter. However, a few hours after the cessation of ice
exposure, the pain recurs with vengeance due to reactive enlargement of blood
vessels after the constriction of blood vessels due to exposure to
ice. This phenomenon causes excellent relief of pain with ice treatment
followed by not only aggravation of pain, but damage to the nerve fibers adding
sympathetic independent pain (SIP) to the original sympathetic mediated pain (SMP)."
"The end result is aggravation of the RSD and SIP resulting in failure of nerve blocks and then the patient is told, "You do not have RSD anymore because the nerve block did not help you and the phentolamine test proved that you do not have SMP or RSD". In most RSD patients ice makes the condition worse and can cause denial of diagnosis and treatment for the patient. One last comment: this study was on advanced cases of RSD. In early stages of RSD, without exposure to ice, there is far lower percentage of RSD patients who from the beginning suffer from permanent damage to large areas of sympathetic nerve fibers with intolerance of heat and secondary erythromelalgia. It becomes obvious that heat-cold challenge physical therapy is nonsensical because it end result is one temperature extreme neutralizing the other and ice challenge further damaging nerve fibers. Please stay away from any ice exposure, even if you cannot tolerate heat."
"The end result is aggravation of the RSD and SIP resulting in failure of nerve blocks and then the patient is told, "You do not have RSD anymore because the nerve block did not help you and the phentolamine test proved that you do not have SMP or RSD". In most RSD patients ice makes the condition worse and can cause denial of diagnosis and treatment for the patient. One last comment: this study was on advanced cases of RSD. In early stages of RSD, without exposure to ice, there is far lower percentage of RSD patients who from the beginning suffer from permanent damage to large areas of sympathetic nerve fibers with intolerance of heat and secondary erythromelalgia. It becomes obvious that heat-cold challenge physical therapy is nonsensical because it end result is one temperature extreme neutralizing the other and ice challenge further damaging nerve fibers. Please stay away from any ice exposure, even if you cannot tolerate heat."
So, when it comes to ice and CRPS
try to remember this; "Ice is NOT nice"!
: "Leslie, I recently had thus discussion with another RSD pt. I would never recommend ice for anyone else, but I do receive positive results with ice. I can only use on a limited area that is affected or I do have problems. The literature from dr h and cryotherapy is from 9 years ago, I have seen newer studies that support much if the evidence, but also have new recommendations. "
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